Medical Schools Should Admit More Guitar Players
Medical Schools Should Admit More Guitar Players
Rebecca L. Volpe
Michael J. Green
0 Department of Medicine, Penn State College of Medicine , Hershey, PA , USA
1 Department of Humanities, Penn State College of Medicine , Hershey, PA , USA
L are indespensable to medical education and practice. It is
ike Mangione and his colleagues, we believe humanities
at best unwise, and at worst impossible, to practice medicine
without the attitudes, skills, and behaviors toward which
medical humanities curricula aim (such as deep listening, empathy,
and ethics). Not only do we personally believe in this work, we
are also privileged to enjoy the support of our institution,
which likely allots more curricular time to humanities than
any other US medical school.1
But teaching medical humanities is only a beginning—it is
also important to evaluate whether such curricula are effective.
And here, the trouble begins, for there is no consensus about
what outcomes humanities ought to be aiming for2–4 or how to
determine if the goals have been achieved.
So, when given the opportunity to review and comment on
Mangione’s outcome study of medical student exposure to
humanities, we were elated. In their study, Mangione and his
colleagues administered a survey to 739 medical students,
asking them questions about their exposure to the humanities and
administering scales for a variety of outcomes: wisdom,
empathy, tolerance for ambiguity, emotional intelligence, self-efficacy,
burnout, and visual-spatial skills.5 To gauge exposure to the
humanities, students were asked to indicate on a scale of 0
Bnever^ to 4 Bdaily^ how often they engaged in the following
humanities activities: visual arts, singing, playing musical
instruments, listening to music, dancing, writing for pleasure, reading
for pleasure, attending theater, going to museums/galleries, and
attending concerts. So far, so good; if exposure to humanities
produces wise, empathic, emotionally intelligent doctors, this
would have important implications for medicine. Indeed, the
authors found that humanities exposure was significantly related
to all ten of the identified outcomes and related most strongly to
tolerance for ambiguity, empathy, and wisdom.5
In discussing the implications of their findings, Mangione
et al. framed their results primarily around curriculum. They
conclude BHence, if we wish to create wiser, more tolerant,
empathetic and resilient physicians, we might want to
reintegrate the humanities in medical education.^5. Though
we agree wholly with this sentiment—that humanities
in medical education may help support the development of
humanistic physicians—the conclusion is not supported by
their study. Quite simply, to draw such a conclusion would
require an entirely different research design.
Rather, we believe their findings are most applicable to
medical school admissions. If the medical education
community believes that it is better for medical students to have high
levels of the personal qualities Mangione et al. measured, then it
makes good sense to take a close look at the admission process.
This would not obviate the need for medical humanities
curricula—the two go together—but why would we not try to
set ourselves off on the right foot by admitting students who
seem to come with a propensity for the skills and attributes we
ultimately seek? This begs a question, however; if (and it is a
big if) we have reliable measures for empathy, wisdom,
emotional intelligence, and so on, then why not simply ask the
questions directly during the preadmission process, rather than
relying on surrogate measures such as the amount of time
applicants spend playing the guitar or drawing? After all, the
authors have not made the case that measuring these
attributes directly is unfeasible or overly burdensome.
A separate argument would need to be made for the value of
humanities in the medical curriculum. Although there is
general agreement about the importance of humanities for medical
education, the evidence base for such curricula is weak.2
Ideally, a multi-site study comparing agreed upon outcomes
is necessary—this would allow us to compare students from
schools that have ample humanities curricula against schools
that have scant humanities curricula. Though there would
certainly be confounders (differences in admission criteria
between schools, for one), this type of comparative outcome
study is sorely needed if we are to develop best practices for
medical humanities curricula.
We also identified some issues with the study design and
methodology that have implications for the interpretation and
generalizability of the results. First, the 23.8% response rate
coupled with the lack of data about non-respondents raises
questions about biases, particularly a concern that respondents
may have been more likely to be Bhumanities-friendly^ than
non-respondents. Relatedly, correlation is not causation, and
there is a significant chicken and egg problem (which the
authors do identify): students who report higher humanities
exposure have more empathy, but we do not know which way
it goes. Does the humanities exposure cause the increase in
empathy or do individuals with high levels of empathy find
themselves drawn to humanities experiences? This matters if
we are to draw meaningful conclusions about the role
humanities interventions should play in medical admissions and
Many medical schools share the common goal of cultivating
humanistic physicians. Unfortunately, it is not yet clear how to
get there. While Mangione’s study does not provide a definitive
road map, the findings do suggest an opportunity to refocus some
of our efforts on the overlooked area of admissions. Accordingly,
more work should be done to explore the impact of humanities in
the formal curriculum and also whether and how to support
current students in their private practice of humanities activities.
We look forward to seeing what comes next.
Compliance with Ethical Standards:
Conflict of Interest: The authors declare that they do not have a
conflict of interest.
1. Klugman CM . Medical humanities teaching in North American allopathic and osteopathic medical schools . J Med Humanit . 2017 ; online first .
2. Ousager J , Johannessen H. Humanities in undergraduate medical education: A literature review . Acad Med . 2010 ; 85 ( 6 ): 988 - 998 .
3. Doukas DJ , McCullough LB , Wear S , PRIME Investigators. Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism . Acad Med . 2012 ; 87 ( 3 ): 334 - 41 .
4. Perry M , Maffulli N , Wilson S , Morrissey D. The effectiveness of artsbased interventions in medical education: A literature review . Med Educ . 2011 ; 45 : 141 - 148 .
5. Mangione S , Chakraborti C , Staltari G , Harrison R , Tunkel AR , Liou KT . Medical students' exposure to the humanities correlates with positive personal qualities and reduced burnout: A multi-institutional U.S. survey . JGIM.. https://doi.org/10.1007/s11606-017-4275-8.